Reproductive Pathology — MCQs

Reproductive Pathology Indian Medical PG Practice Questions and MCQs

Question 301: Dimpling in carcinoma of the breast is due to

A. Scarring
B. Edema
C. Contraction of Cooper's ligaments (Correct Answer)
D. Subdermal lymphangitis

Explanation: ***Contraction of Cooper's ligaments*** - **Dimpling** or **skin retraction** in breast carcinoma occurs when the tumor invades and shortens the **suspensory ligaments of Cooper**, pulling the overlying skin inward [1]. - These ligaments normally provide support to the breast tissue; their involvement by tumor tissue is a classic sign of breast cancer [1]. *Edema* - While significant **edema** can be associated with breast cancer (e.g., **peau d'orange**), it typically presents as generalized swelling and thickening of the skin, not focal dimpling [1]. - Edema results from **lymphatic obstruction**, causing fluid accumulation, rather than direct retraction [1]. *Subdermal lymphangitis* - **Subdermal lymphangitis** is an inflammation of the subcutaneous lymphatic vessels, often due to infection or occasionally malignancy. - It usually presents as red, tender streaks or diffuse thickening, not discrete skin dimpling. *Scarring* - **Scarring** within the breast tissue from previous surgery, trauma, or inflammation can cause skin retraction. - However, in the context of an unstated precipitating event and given "carcinoma," tumor invasion of **Cooper's ligaments** is the more direct and primary cause of dimpling. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 453-454.

Question 302: Which of the following breast lesions is associated with the HIGHEST risk of developing invasive breast cancer?

A. Sclerosing adenosis
B. Simple fibroadenoma
C. Florid hyperplasia
D. Atypical hyperplasia (Correct Answer)

Explanation: ***Correct: Atypical hyperplasia*** - **Atypical hyperplasia** (either atypical ductal hyperplasia [ADH] or atypical lobular hyperplasia [ALH]) represents a proliferative lesion with some, but not all, features of carcinoma in situ [1] - Associated with a **4-5 times greater risk** of developing invasive breast cancer compared to the general population - Characterized by disordered architectural patterns and cellular atypia, indicating a **significant increased risk** for future malignancy [1] - Considered a high-risk lesion requiring close surveillance *Incorrect: Sclerosing adenosis* - This is a **benign proliferative lesion** characterized by increased glandular elements and stromal fibrosis - Confers only a **slightly increased risk (1.5-2 times)** of breast cancer - While it can sometimes mimic carcinoma on imaging, it is generally considered a **low-risk lesion** *Incorrect: Simple fibroadenoma* - A **simple fibroadenoma** is a benign tumor composed of both glandular and stromal tissue - **Does not increase the risk** of breast cancer - Typically presents as **well-circumscribed, mobile masses** and is among the most common benign breast lesions *Incorrect: Florid hyperplasia* - Also known as **usual ductal hyperplasia without atypia** - Involves an increase in the number of epithelial cells within the ductal lumen but lacks cellular atypia - Carries a **minimal increased risk (1.5-2 times)** for developing invasive breast cancer - The absence of atypia distinguishes it from the higher-risk atypical hyperplasia **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1054-1056.

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